Managing Symptoms to Improve Lives for Those with Schizophrenia

Schizophrenia study
A national study is trying new approaches to give hope to schizophrenia patients.

A grant of more than $9.3 million will help launch new technologies and strategies to care for patients with schizophrenia at The Zucker Hillside Hospital campus of The Feinstein Institute for Medical Research. The study, called “Using Care Managers and Technology to Improve the Care of Patients with Schizophrenia,” is being led by John Kane, MD, Zucker Hillside’s chair of psychiatry and the health system’s vice president of behavioral health services.

The Centers for Medicare and Medicaid Services (CMS) awarded the three-year grant in an effort to improve clinical outcomes, quality of life and treatment satisfaction for patients with schizophrenia while lowering healthcare costs. Dr. Kane and his team are using the funds to train care managers at 10 United States locations, including Zucker Hillside, to use evidence-based behavioral health protocols and new healthcare technology. Patients enrolled in the study will later use this technology after discharge from an inpatient setting following treatment for an acute schizophrenic episode.

“We want to determine if mobile applications and interactive messaging will prompt medication compliance, facilitate coping with hallucinations and improve social support,” Dr. Kane said. “We hope that by delivering proven cognitive behavioral therapies via the Internet and providing self-directed tools such as psycho-education resources, we can help patients recognize symptoms and get help in time to avoid post-discharge relapse.”

Improving Ongoing Care Management

The vulnerable weeks immediately following discharge — and the documented danger of relapse during this time — are at the core of the study’s focus. “People may stop taking their medication. There may be poor transitions between care settings,” Dr. Kane explained. “The study is our attempt to truly get a sense of how people are feeling and functioning on a day-to-day basis. The goal is to make adjustments to treatment and challenge thought patterns before symptoms become overwhelming and a visit to the local emergency department seems like the only option.”

The study will enroll individuals within 30 days of hospital discharge. Patients will participate in the study for six months. Each patient will receive a laptop computer and smartphone loaded with a variety of software developed through a research consortium that includes Dartmouth University, Boston University and the University of Pittsburgh. In addition to providing access to psychoeducation resources, these applications will allow patients to set medication reminders and receive interactive cognitive behavioral therapy. “We’re very interested in learning how patients will accept and use these new technologies,” Dr. Kane said.

Care manager training is already under way at Zucker Hillside. The hospital, which is leading the study, will have the largest enrolled patient population at 200 patients. Care managers — including case managers, rehabilitation counselors and other behavioral healthcare professionals — will guide patients in the use of study technologies and facilitate the exchange of information between the care team, the patient and the patient’s family. However, Dr. Kane stressed that the study is not intended to replace a patient’s regular contact with a therapist or physician. “If a patient only sees the therapist one day a week, the program can help fill gaps in care for the other six days. By providing connecting technologies, we hope to enhance care access and care quality.”

Mitigating Schizophrenia’s Costs

Schizophrenia is the third leading cause of disability for people ages 15 to 44 and affects 2.2 million Americans. Symptoms usually develop in men in their late teens and early 20’s — a time typically meant for seeking out education, job training and romantic attachments. The disease affects women in smaller numbers, who are usually diagnosed slightly later than men. A small number of cases in both women and men are identified in childhood.

Because it affects cognition as well as behavior and mood, schizophrenia is a complex illness to manage. In terms of treatment and lost productivity, total costs associated with schizophrenia exceed $75 billion per year in the United States. Improved post-discharge care is expected to lower this figure, and this potential for cost savings is an important driver of the CMS grant.

Schizophrenia affects so many domains of function and typically arises during a time of significant personal development, so the cost to the individual is also high, Dr. Kane noted. “Imagine you’re trying to return to work or attend school and then you get sick again,” he said. “Inpatient treatment can be extremely disruptive if you’re trying to achieve an independent life.”

The study is a concerted effort to bring together innovative strategies that can help patients stay on a healthy trajectory after achieving stabilization in inpatient care. “We’re viewing this study as a way to apply proven symptom management techniques in new ways to ensure uniform care, mitigate the disruptive nature of this disease, and deliver the kind of treatment that helps people manage stress and get back to the things their illness is preventing them from doing,” said Dr. Kane.

Personnel trained at Zucker Hillside and several other study sites share Dr. Kane’s hope that results of the study will positively influence the nature of ongoing care for persons with schizophrenia. “We are all excited about the study’s potential for producing helpful, long-term results that will significantly improve our patients’ quality of life,” Dr. Kane said.

From the Winter 2013 issue of Focus on Behavioral Health.

Schizophrenia and Innovative Research Strategies

Dr. John Kane and his colleagues at The Feinstein Institute for Medical Research and The Zucker Hillside Hospital have helped to determine treatment strategies for all phases and subtypes of schizophrenia. His findings have been circulated worldwide and have become part of the fabric of modern care. In addition, he and his team are studying the use of new technologies – from smartphones to social media – to improve patient engagement, adherence monitoring, and clinical decision-making.

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